FCC publishes net neutrality repeal order, so what's next?

The rollback will come into place in just two months and healthcare organizations should prepare for several potential changes that could touch telehealth, blockchain, AI and connectivity.

The Federal Communications Commission late last week published its order to repeal net neutrality, which is the final step necessary to remove the Obama-era regulations. It also started the 60-day clock until the rules are removed on April 23.

The publication of the rule is a crucial milestone for those who oppose FCC’s repeal, as it initiates the countdown for individuals or organizations to challenge the ruling. Several attorneys general and other net neutrality supporters have already petitioned the court following the FCC’s decision in December, but will have a 10-day window to refile now that the rule has been officially published.

Publication also starts the timeline for Congress to pass legislation to invalidate the repeal with the Congressional Review Act, which gives Congress 60 days to pass a resolution. Democrats are making the push to do just that, and some Republicans have voiced support, as well.

But if the net neutrality repeal goes through, it can have several impacts on the healthcare industry. Given the need for a free, open internet to ensure connectivity, digital health and telemedicine can thrive, it’s important for hospitals and other healthcare organizations to brace for what could become some significant changes.

Cost concerns and telemedicine repercussions

While FCC Chairman Ajit Pai has argued a repeal of net neutrality will boost telemedicine, many healthcare professional groups have stressed that won’t be the case. To the American Academy of Pediatrics, fast lanes could allow ISPs to charge higher fees for services.

Cloudbreak Health CEO Jamey Edwards, for instance, said the healthcare sector should be concerned about these potential costs.

“The bottom line is that things are going to get more expensive for hospitals and care providers,” said Edwards. “Whether that’s a direct cost charged by their ISP, or incorporated into solution providers, they will pay more as they perceive they need faster, higher quality bandwidth.”

The issue is that healthcare organizations rely on the internet to ensure care quality, access and the like. While consumers are concerned for the sake of on-demand entertainment and internet access, Edwards argued that, “care is mission critical and there can’t be slow or choppy connections.”

As costs are already an issue for many healthcare providers -- especially in rural areas, Edwards said that most users will land in the basic tier.

“Costs are going up,” said Lisa Schmitz Mazur, a partner at international law firm McDermott, Will & Emery. “Telemedicine equipment is more affordable than in the past, but if we add on to costs with paying more to ISPs or for better quality of internet, it could be a problem for some.”

As a result, Mazur said that many hospitals may need to cut back on telemedicine programs, as they can’t cut down on the quality of internet. And many hospitals are already concerned with implementing telemedicine programs as it adds to costs.

“There’s a lack of reimbursement for those services,” said Mazur. “If that gets better we can justify those costs. But we didn’t see a lot of increase in revenue despite high hopes.”

Edwards’ concerns mirror Mazur’s: Larger organizations and providers will be able to afford these services, but smaller companies won’t be able to compete. As a result, the industry may see unfair trade practice between ISPs and larger telehealth providers, as smaller vendors can’t negotiate into exclusive agreements as easily.

Strange bedfellows

The shift into a world without net neutrality may create some new partnerships -- some obvious, others not so much.

“We’ll see some strange bedfellows emerge,” said Edwards. “Large ISPs will start to see opportunity in catering to the healthcare community.”

Edwards also sees the extreme happening, where large healthcare product suppliers could buy ISPs to add the service to their offered products. Not only that, but big corporations may even consider becoming an internet provider.

Right now, ISPs will likely want to “cement as many key ‘paid’ relationships as possible, to take advantage of this dramatic change in how the internet is being managed,” said Edwards. “I predict that in the beginning, ISPs will leverage this content within a priority service, free-of-charge.”

Further, ISPs will work with content providers to better understand the willingness to pay for the fast lane. Edwards explained that ISPs could begin throttling back capacity for users and content providers to “give them a taste of what not being in the fast lane would be like.”

“The big question is what price will the market bear for access to better quality, and speed and where the ISPs will set standard bandwidth,” said Edwards. “Service providers will need to evaluate their cost structures and begin quantifying the impact on their ability to either cover the additional bandwidth costs or pass them on to the consumer, which is a strong possibility.”

Providers may also contract with technology and platform companies that insulate their partners from a lack of net neutrality, by connecting through private path broadband alternatives.

How healthcare organizations can soften the blow

Right now, Mazur said hospitals and technology companies are determining whether they should appeal to FCC to get some clarification on how the rule will directly affect their operations.

While most were glad to see that FCC also voted to improve funding for the Rural Health Care Program at the same time net neutrality was repealed, neither addressed issues for urban areas, “especially for those who don’t have money to pay for preferential treatment.”

“Most of the industry has been in a wait-and-see mode,” said Mazur. Tech innovators are joining forces with similar companies to appeal to FCC, as there’s strength in numbers. And companies with resources available for marketing experts and lobbying groups are making that push in Washington, D.C.

Mazur said she’s encouraging all of her digital health clients with concerns to talk to each other and “come up with a plea to offer some kind of protection.”

For other healthcare organizations, Mazur said she is seeing some waiting to purchase tech or telemedicine tools that require bigger bandwidth. But others are pushing through, and working with ISPs to discuss “how preferential treatment an have a debilitating impact on innovation.”

Two other areas of concern are for blockchain and AI, as “high-quality internet is a foundational requirement for these types of disruptors to really function with existing and new systems,” said Mazur. “Everyone is talking a lot about the potential opportunities that both will bring to healthcare and other industries, and the repeal could have an impact on both,”

In the end, the repeal of net neutrality and its impact will come down to the technology user, and whether they can afford to pay for the higher quality, Mazur explained. “But right now it’s all just speculation.”